Cardiology

Women underrepresented in guideline-referenced ischemic heart disease trials

Systematic review of 1690 studies cited in ACC/AHA guidelines found women comprised 29.5% of revascularization trials. Women made up 33.3% of chronic coronary artery disease trials and 40% of chest pain trials. Participation-to-prevalence ratios ranged 68.2%–83.2%, indicating enrollment gaps versus disease burden. Authors call for proactive enrollment strategies to improve representation and generalizability of guideline evidence. 1

Digoxin reduced composite death or new/worsening HF in symptomatic rheumatic heart disease

In 1769 patients with symptomatic rheumatic heart disease, digoxin reduced the composite of all-cause death or new/worsening heart failure (31.4% vs 35.5%; HR 0.82, 95% CI 0.70–0.97). New or worsening heart failure alone was similarly reduced (25.8% vs 29.2%; HR 0.82, 95% CI 0.69–0.98). All-cause mortality was similar between groups (10.0% vs 10.4%; HR 0.94, 95% CI 0.70–1.26). Serious toxicity was uncommon; 1.1% on digoxin permanently discontinued for suspected toxicity versus 0.1% on placebo. 2

Risk-stratified ED disposition and transitional care work similarly for men and women with acute HF

Secondary analysis of 5452 acute HF ED patients found no sex interaction at 30 days; HRs were 0.88 for both sexes for death or cardiovascular hospitalization. No sex interaction was seen for the 20-month composite outcome either (HR 0.99 females, 0.92 males; P for interaction .38). There was a sex interaction for 20-month HF readmissions, with benefit favoring males (adjusted HR 0.71) but not females (adjusted HR 0.92). Findings support applying risk-guided ED disposition and transitional care broadly, while monitoring longer-term readmissions by sex. 3